“There’s a lot of things being referred to as putting lipstick on a pig, but this is truly putting lipstick on a pig,” Tester said in speech delivered from the Senate floor. “In essence what we’re going to do next week, because some folks in this body forgot to read the Affordable Care Act when it came up, we’re going to repeal it and replace it with a piece of garbage.”

At issue is the Senate Republican bill to repeal and replace the 2010 Affordable Care Act, better known as Obamacare. Since the ACA’s 2010 creation without GOP support, Republicans have vowed to replace it, objecting to the law’s mandate that all Americans buy health insurance and that states be empowered to offer Medicaid to people too poor afford coverage.

A House version of the repeal bill is estimated to eliminate insurance for 23 million people, according to the nonpartisan Congressional Budget Office. But the bill would also cut government spending by $119 billion over 10 years, a Republican goal. Most of the savings would come from cutting Medicaid and subsidies currently used to make insurance more affordable for individuals paying for coverage.

In Montana, more than 77,000 people on Medicaid would lose coverage under the House bill, according to the Montana Healthcare Foundation. The state would lose $4.8 billion from 2020 through 2026 as federal Medicaid support was wound down.

The Montana Healthcare Foundation was created in 2013, and came into existence as a result of the sale of Blue Cross and Blue Shield of Montana to a private corporation. In accordance with state law, the assets were transferred to a charitable trust to be managed for public benefit. The foundation didn’t take a position on the House bill, known as the Affordable Health Care Act.

Little is known about the Senate version of the bill, which is being crafted in private by 13 Republican senators. Senate Majority Leader Mitch McConnell, of Kentucky, said Tuesday the bill would be published Thursday with a vote by the full Senate expected by the end of next week.

A week is not enough time for a bill that is expected to dramatically change health care for millions of Americans, said Tester and other Democrats, who want public hearings on the bill and an opportunity to make amendments. Health care accounts for one-sixth of the value of all U.S. goods and services.

Most Republicans, including U.S. Sen. Steve Daines, R-Mont., have said they haven’t seen the bill, either. However, no one in the Republican majority has said they will vote against the bill next week.

Democrats began speaking on the Senate floor in evening session Monday to slow down Senate business in hopes of buying time for lawmakers and the public to read the bill before it goes to a vote. Joining colleagues Tuesday, Tester said cutting Medicaid spending would damage 48 rural Montana hospitals that rely on the program to pay for the medical expenses of the poor, including working Montanans earning 138 percent of the federal poverty level, or about $16,300 annually.

Tester has advocated for keeping the Affordable Care Act, but making changes where needed to make the existing health insurance policy better. Recalling a conversation with a Butte man on Medicaid, the senator promised not to let Senate Republicans escape public scrutiny if they made health care worse for Americans.

“He said ‘you know, I’ve had diabetes since I was a teenager. I’ve had some issues with mental health for a good portion of my adult life,’” Tester said the Butte man told him. “He said ‘you know I haven’t been able to support my family, and then the Affordable Care Act came along, and the state of Montana was wise enough to pass Medicaid expansion. I was able to go to a doc. I was able to get my diabetes handled because of Medicaid expansion. I was able to see a psychologist and get my mental health issues under control. And I was able to go back to work. I was able to support my family, and now you guys back in Washington, D.C., want to take that all away from me.’

“Well I will tell you,” Tester said. “I will fight like hell to make sure that never happens. And if the majority leader wants to try to ram this down people’s throats, I will spend the rest of my life telling them why, and who did what to them.”